ANNEX- I

Prescribed Application Form Domestic Students

Name & Full Address of :
the institution

Latest passport size

photograph of the student

Institutes Phone No. :

1. B I O - D A T A
Full Name : Mrs / Ms / Mr
(Surname first)

Date of Birth

Full Postal Address

for communication

Telephone
No.

Institution

Residence
Mobile
E-mail

:
:
:

Educational Qualifications :
Exam
Univ. / Institute

Age :

Year of
Passing

% of Marks *

Subjects
(Arts / Commerce
/ Science / Tech.
etc.)

*Applicants with CGPA marks must indicate as such and also normalise them to bring them on par
with other students by applying the formula of their university , if officially provided by the
university.
Additional Qualifications
(CA / ICWA / Computers, etc.)

Name of the current course being

pursued

Subjects of Specialization / Interest

Work Experience

Extra-Curricular Activities

Projects undertaken

Project Preferences
(Please note that it may not always be
possible to allocate project of your
choice)

I certify that the above information furnished by me is true to the best of my knowledge
and belief.
Place

Date

Signature :

Name

2. Authentication of particulars furnished in (1) above by the

Institute / University
This is to certify that the information furnished by Mr. / Ms / Mrs. ___________________
in the form of application at (1) above is correct to the best of our knowledge.
Recommendations, if any

Signature & Seal of Authorised Official